Pulley-bone Problems

If you were to tell a friend that you were having trouble with your “sesamoids”, you’d probably get a funny look or a blank stare in response. While knee problems or a broken collar bone (for example) are rather easy for people to identify with, sesamoid complications are more obscure and not as easily recognized. Nevertheless, issues involving the sesamoids can cause big problems for people and lead to severe pain and irritation underneath the big toe. The name may sound funny, but the symptoms in question are definitely not!
So what exactly is a “sesamoid” anyway? Glad you asked! In order to wiggle our toes or perform any other critical toe motions, our feet contain tendons which run along the tops and bottoms of our toes. When these tendons are shortened, are toes are able to move up or down according to our needs. Anyway, as you might have assumed, the big toe is very important. Over 50% of our body weight is transferred through the ball of the foot and into the big toe during normal walking and other activities. “Sesamoids” are small, rounded, and independent bones which are located in pairs on the underside of each ‘ball’ region of the foot just behind the big toe. About the size of jelly beans, they work almost like a pulley to increase the force of the major tendon which runs between them and out to the end of the big toe. They also help to absorb and transmit pressure and to reduce friction in the area.
Like any bones, the sesamoids in particular are susceptible to disease, possible infections, and fractures especially given their location in such a pressure-prone area of the body. Repetitive motions such as walking on a treadmill with inappropriate shoes or sporting injuries may contribute to complications. Generally, people will have pain, tenderness, swelling, and possible numbness in the area. These symptoms are often exacerbated by climbing stairs, exercising, or other activities which stress the area by forcing the big toe to bend upwards. Consequently, people will often times begin to shift weight to the outer borders of their feet in order to walk in such a way that they off-load the tender inner area behind the big toe.
Symptoms of this nature certainly warrant examination by your podiatrist. He or she will typically order some specific X-rays to isolate the injury and rule our arthritis, nerve damage, or any other potential diagnoses. Because the ball of the foot is such a critical joint, it contains many structures and thus many potential problems! Once sesamoid pathology is determined, the nature of it as well as treatment options can be discussed between you and your podiatrist. Nonsurgical possibilities may include special casts, boots, and padding as well as steroid injections, off-loading, and other modalities. Surgical options might entail bone-grafting, procedures to raise the ball of the foot, and even excision or removal of one of the sesamoids. It all depends on the unique nature of your condition.
Ideally, your sesamoid bones should work for you and not against you. When this is not the case, thankfully, quality help is available.


Advanced Foot Care
Robert E. Kuvent, DPM
3225 S Alma School Rd
Chandler, AZ 85248
480.917.2300
http://yourfeetfixer.com